PL-17-2175Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PL -8-17-2175
Permit Type: Plumbing - Residential
Work Classification: Septic
Permit Status: APPROVED
Issue Date: 8/31/2017 1 Expiration: 02127/2018
Parcel Number
Applicant
90 NE 104 Street
Miami Shores, FL 33138-2027
1121360130860
Block: Lot:
EVAN AND MARIKA PINE
Owner Information
Address
Phone
Cell
EVAN AND MARIKA PINE
90 NE 104 Street
Miami Shores FL 33138-2027
90 NE 104 Street
Miami Shores FL 33138-2027
Contractor(s) Phone
MR C'S PLUMBING & SEPTIC INC (305)651-7859
Cell Phone
Valuation:
Total Sq Feet:
$ 3,500.00
0
Type of Work: SEPTIC TANK AND DRAIN FIELD
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$2.40
$2.00
$2.00
$0.80
$150.00
$9.00
$3.20
$169.40
Pay Date Pay Type
Invoice # PL -8-17-65011
08/29/2017 Credit Card
08/31/2017 Credit Card
Amt Paid Amt Due
$ 50.00 $ 119.40
$ 119.40 $ 0.00
Available Inspections:
Inspection Type:
HRS Approval
Final
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work do ither yself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WIN a eI •0 S, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing inf,'rmatio s = . -= all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-• -n%f • to do the work stated.
Authorized Signature: Owner / Applicant /
Building Department Copy
Contractor / Agent
August 31, 2017
Date
August 31, 2017 1
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-
INSPECTION LINE PHONE NUMBER: (305 762-4949
EcEIV E°
8972 AUG 2 910111
F�BC� 20N
Master Permit No. I L -I ""?\ ns
Sub Permit No. PL -3-16-614
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION Q RENEWAL
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 90 NE 104 Street
City: Miami Shores
Folio/Parcel#:11-2136-013-0860
Occupancy Type:
Countv:
Miami Dade Zip: 3 ) 3g
Is the Building Historically Designated: Yes NO X
Load: Construction Type: Flood Zone: BFE:
OWNER: Name (Fee Simple Titleholder): Evan Pine
Address: 90 NE 104 Street
FFE:
Phone#:
City: Miami Shores
Tenant/Lessee Name: NA
State: FL Zip: 33138
Phone#:
Email:
CONTRACTOR: Company Name: Mr. C's Plumbing & Septic
Address: 19932 NW 2 Avenue
Phone#: 305-651-7859
City: Miami
Qualifier Name:
State Certification or Registration #: SR061536
DESIGNER: Architect/Engineer: NA
Address:
Kemble Ettrick
State: FL Zip: 33169
Phone#:
Certificate of Competency #:
Phone#:
City: State: Zip:
Value of Work for this Permit: $ 5 03•
Square/Linear Footage of Work: 200
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace n Demolition
Description of Work: Renewal of permit �� _I(p — CON
t
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 1 c0" " " CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $ (,, j
Structural Reviews $ Bond $ 1 L I'� `O a -
TOTAL FEE NOW DUE $ l9.
(Revised02/24/2014)
Bonding Company's Name (if applicable) NA
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) NA
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
3 day of q`t/L.3UL5 t , 20 1- , by
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
moteeeiyi.►►•• DONALD MARTIN
a , •• MY COMMISSION # GG102743
„
EXPIRES May 09, 2021
i
*******************************
APPROVED BY
(Revised02/24/2014)
R
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
%J
/7/15 day of ti44 , 20 /7 , by
124th 64te/CA. , who is personally�ppap to
me or who has produced _ as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Apt Zit NArr/'1
***************************************
101§9-- Plans Examiner
Structural Review
:"°• DONALD MARTIN
��T MY COMMISSION # GG10274:i
'n,;a '`
.?, EXPIRES May 09, 2021
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION., PERMIT
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Evan Pine
PET #: 13 -SC -1660676
APPLICATION 0: AP1224872
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #:PR1007779
PROPERTY ADDRESS: 90 NE 104 St Miami, FL 33138
LOT: 1 2
BLOCK: 123 SUBDIVISION:
PROPERTY ID #: 11-2136-013-0860
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ] GALLONS / GPD Septic #1 (New Tank) CAPACITY
A [ 900 ] GALLONS / GPD Septic #2 (Existing) CAPACITY
N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY I ' ]GALLONS 81 IDOSES PER 24 HRS #Pumps I ]
D [ 200 I SQUARE FEET
R [ 318 1 SQUARE FEET
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK: FFE 13.1' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: 10.00 ] INCHES
Bed Drainfield #1 (New) SYSTEM
Bed Drainfleld #2 (Existing SYSTEM
[x] STANDARD [ ] FILLED [ I MOUND [ ]
[ ] TRENCH [x] BED [ l
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
[ 24.00 I [I INCHES / FT ] I ABOVE 4 BELOW li BENCHMARK/REFERENCE POINT
[ 64.00 ] II INCHES Y F I [ ABOVE 4 BELOW II BENCHMARK/REFERENCE POINT
EXCAVATION REQUIRED: [ 52.001 INCHES
**THIS PERMIT IS NOT FOR ADDITIONS** (Repair of System #1 ONLY)
*Install 12" of slightly limited soil at the bottom of the drainfield.
*Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed_
*Invert elevation of drainfield to be no less than 8.27' NGVD.
*Bottom of drainfield elevation to be no less than 7.77' NGVD.
*The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E -6.013(3)(f), FAC.
TITLE:
TITLE: Engineering Specialist II
DATE ISSUED: 03/03
Dade
EXPIRATION DATE: 06/01/2016
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC
v 1.1.4 AP1224872 SE987492
CHD
Page 1 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet
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There are no pertinent features on adjacent properties and or across the street that may affect the New Septic system installation.
Notes:
'10 .Al a 10't Sk KutvA:
thaJl& its lot retikteA .Ser• ^}-b G -e ret kt-c ) —
Site Plan submitted by: Ce1ut
Plan Approved
By County Health Department
Not Approved
Date .�lIf1Ic.
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 10/96 (Replaces HRS -H Farm 4016 which may be used)
(Stock Number. 5744-002-4015-6)
Page 2 of 4